The Impact of Multilateral Agreements on Future Health Workforce Supply and Governance? Australia and ASEAN Region

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1 The Impact of Multilateral Agreements on Future Health Workforce Supply and Governance? Australia and ASEAN Region Lesleyanne Hawthorne Professor International Health Workforce 15 th International Health Workforce Collaborative Day 4 Plenary London + Cambridge May 2015

2 Australia s Level of Reliance on Migrant Health Professionals Recent Growth in Skilled Migration 500, , , , ,000 Persons 250, , ,000 Net Migration 100,000 50,000 0 Natural Increase Year

3 Numbers Recent Growth in Skilled Migration Field Arrivals Arrivals Engineering 18,790 41,407 Accounting 26,145 35,423 IT 22,630 31,968 Education 15,400 29,464 Nursing 8,584 16,154 Medicine 7,241 12,696 Nursing (Diplomas) 5,649 10,194 Pharmacy 1,798 3,005 Dentistry 1,063 2,343 Physiotherapy 755 1,556 Total (All Degrees) 192, ,611

4 Latest Trends Arrivals 30 June KEY POLICY ISSUE: WHICH ISTHE BEST SOURCE? Temporary skilled migrants (no cap ): 8,120 doctors, nurses and dentists permitted to work up to 4 years (compared to 2,780 in ) Permanent skilled migrants: 4,719 doctors, nurses and dentists selected (compared to 1,935 in ) Family and Refugee migrants: Uncounted by very substantial Example: Myanmar, Afghan and Iraq-qualified doctors

5 ASEAN: Priority Goals (Accelerated Activity and Pressure 2015+) Goal of regional mobility/ recognition: 7 priority fields including Medicine, Nursing, Dentistry Range of members on human capital development index: 1. Very high development: Singapore, Brunei 2. High development: Malaysia 3. Medium development: Thailand, Indonesia, Philippines 4. Low development: Vietnam, Cambodia, Laos, Myanmar Regional free-trade agreement links with ASEAN: China, Korea, Japan, Australia, New Zealand

6 Potential Impact of Trade-Driven ASEAN Multilateral Agreement Including Goods and Services Strong + growing demand: For access to Australian health workforce employment BUT Major regional workforce mobility challenges: Educational resourcing Educators qualifications and experience Training quality assurance Private sector governance + over-production Clinical infrastructure Level of technological development Source country disease patterns (etc)

7 Case Study: Calibre of Nurse Education in the Philippines (also the second top global source of medical migrants) Quality assurance: Voluntary (not mandatory) Few institutions engaged Nursing schools (1970s): 40 nationally Nursing schools (2005): 441 nationally! 332,206 nurses trained (as export commodity) 29,467 employed nationally compared to 163,756 overseas Vast numbers unemployed (seeking migration) Nursing school issues: Most = private colleges Many with lax entry standards, minimal QA, invisible Faculty, linked to migration agents, infiltration of regulatory bodies. Impact of language + training case study: Filipino and Indonesian nurse migration to Japan (1-2% pass the national nurse registration exams compared to 80% from China)

8 Case Study: Medical Graduate Over-Production in Malaysia Public sector medical schools: 9 Entry standards: 4 A-Levels Quality assurance: Strong Growth in private sector: Number of new medical schools approved Pipeline applications for approvals Lower entry levels Graduate destinations?

9 Regional Health Professionals English Ability? (Occupational English Test Outcomes ) Nurses (17%) Pharmacists (38%), Doctors (52%), Dentists (62%) Candidate pass rate (%) 70% 60% 50% 40% 30% 20% 10% 0% 53% 43% 52% 20% 19% 17% 40% 47% 62% 38% 39% 38% 34% 32% 28% 46% 40% 37% 41% 32% 34% %

10 Impact of Language Testing on Migrant Nurse Pass Rates: By Select ASEAN Country (2005 and 2010) 100% Proportion of nursing candidates passing OET by select country of training, 2005 and % 100% Nursing candidate pass rate (%) 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 58% 0% 42% 36% 34% 33% 24% 23% 22% 21% 20% 8% 20% 20% 17% 17% % 13%

11 Doctors: Variable Registration Pathways? X Fast Medium Slow Specialists

12 Migrant Doctors Access to Medical Employment in Australia (First 5 Years) Permanent Residents 2011 Census: Overall: 57% of arrivals employed in medicine within 5 years Most likely to practice: South Africa (83%), Malaysia (75%), UK/Ireland (74%), SE Europe (61%), India (61%), West Europe (59%), Singapore (56%) Modest performers: Philippines (46%), South/ Central America (42%) Poor outcomes: East Europe (27%), Vietnam (12%), China (8%), Indonesia (4%) Unemployed or Not in the labourforce within 5 years: China = 43%, Japan/ South Korea = 44%, Vietnam = 65%, Indonesia = 65% Looming pressures eg ASEAN (health sector focus)

13 Australian Medical Council MCQ + Clinical Pass Rates on 1-4 Attempts - By Select Candidate Source Country 2013 (NB: UK, Ireland, US, Canada, NZ Registrants Largely Exempt) MCQ Exam (No = 2,885) 1. Sri Lanka: 78% 2. Singapore: 75% 3. Myanmar: 69% 4. Malaysia: 67% 5. Germany: 66% 6. South Africa: 63% 7. Iran: 62% 8. Pakistan: 57% 9. India: 54% 10. Bangladesh: 52% 11. Egypt: 45% 12. China: 42% 13. Russia: 41% 14. Philippines: 33% Average: 55% Clinical Exam (No = 2252) 1. Germany: 82% 2. Sri Lanka: 54% 3. South Africa: 53% 4. Singapore (no candidates) 5. Malaysia: 50% 6. Iran: 47% 7. Myanmar: 47% 8. Pakistan: 46% 9. China: 46% 10. Egypt: 42% 11. India: 40% 12. Russia: 37% 13. Bangladesh: 35% 14. Philippines: 28% Average: 43%

14 International Students as an Australian Health Workforce Resource: The Study-Migration Pathway Compared to standard migrants self-funded to meet local requirements: 1. Fully recognised qualifications 2. English testing exemption (IELTS 7 on enrolment) 3. Youth + future productivity (aged 24 years) 4. Local experience 5. Acculturation

15 Former International Students: Full-Time Employment Rates 6 Months After Completing Australian Degrees by Field Compared to Domestic Students ( ) Qualification Field Australian Graduates (Sample = 371,000) International Students (Sample = 79,000) Accounting 83% 35% Business 76% 40% IT 78% 42% Engineering 86% 44% Medicine 100% 99% Dentistry 94% 96% Pharmacy 98% 96% Physiotherapy 94% 67% Nursing 92% 71%

16 Future - ASEAN Health Workforce Governance Challenges? Australia and New Zealand: Region: Increasing over-production for remittance generation Sector: Driven by private sector colleges (lower entry and achievement standards eg Malaysian medical schools QA: Potentially conflicted QA and regulation strategies Demand: Likely scale of ASEAN + regional demand for mobility/ recognition Trade pressures: Versus research evidence Pathway and source country: Which health workforce migrants? Medical tourism: Outsource health services to cheaper regional providers? Inappropriate pressure? Case study: Nursing

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